title: Decreased response to inhaled steroids in overweight and obese asthmatic children.
abstract: BACKGROUND
  The mechanisms and consequences of the observed association between obesity and childhood asthma are unclear.
  
  
  OBJECTIVE
  We sought to determine the effect of obesity on treatment responses to inhaled corticosteroids in asthmatic children.
  
  
  METHODS
  We performed a post hoc analysis to evaluate the interaction between body mass index (BMI) and treatment with inhaled budesonide on lung function in the Childhood Asthma Management Program trial. Participants were then stratified into overweight/obese and nonoverweight groups, and their response to inhaled budesonide was analyzed longitudinally over the 4 years of the trial.
  
  
  RESULTS
  There was a significant interaction between BMI and budesonide for prebronchodilator FEV(1)/forced vital capacity (FVC) ratio (P = .0007) and bronchodilator response (BDR; P = .049) and a nonsignificant trend for an interaction between BMI and budesonide on prebronchodilator FEV(1) (P = .15). Nonoverweight children showed significant improvement with inhaled budesonide in lung function (FEV(1), FEV(1)/FVC ratio, and BDR) during the early (years 1-2) and late (years 3-4) stages of the trial. Overweight/obese children had improved FEV(1) and BDR during the early but not the late stage of the trial and showed no improvement in FEV(1)/FVC ratio. When comparing time points at which both groups showed a significant response, the degree of improvement among nonoverweight children was significantly greater than in overweight/obese children at most visits. Nonoverweight children had a 44% reduction in the risk of emergency department visits or hospitalizations throughout the trial (P = .001); there was no reduction in risk among overweight/obese children (P = .97).
  
  
  CONCLUSIONS
  Compared with children of normal weight, overweight/obese children in the Childhood Asthma Management Program showed a decreased response to inhaled budesonide on measures of lung function and emergency department visits/hospitalizations for asthma.
authors.affiliation: Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass, USA. eforno@med.miami.edu
authors.forename: Erick
authors.initials: E
authors.lastname: Forno
authors.forename: Rachel
authors.initials: R
authors.lastname: Lescher
authors.forename: Robert
authors.initials: R
authors.lastname: Strunk
authors.forename: Scott
authors.initials: S
authors.lastname: Weiss
authors.forename: Anne
authors.initials: A
authors.lastname: Fuhlbrigge
authors.forename: Juan C
authors.initials: JC
authors.lastname: Celedón
mesh_terms: D000280:Administration, Inhalation; D001249:Asthma / Q000188:drug therapy*; D001835:Body Weight; D002648:Child; D004351:Drug Resistance; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications*; D050177:Overweight / Q000150:complications*; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D013256:Steroids